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UPI
03-07-2025
- Health
- UPI
Medicaid cuts would leave the working class more vulnerable
The Congressional Budget Office estimates that 7.8 million Americans across the United States would lose their coverage through Medicaid -– the public program that provides health insurance to low-income families and individuals -– under the One Big Beautiful Bill Act making its way through Congress. Photo by Jonathan Borb/ Pexels The Congressional Budget Office estimates that 7.8 million Americans across the United States would lose their coverage through Medicaid -- the public program that provides health insurance to low-income families and individuals -- under the One Big Beautiful Bill Act making its way through Congress. That includes 248,000 to 414,000 of my fellow residents of Michigan, based on the House Reconciliation Bill in early June 2025. There are similarly deep projected cuts within the Senate version of the legislation. Many of these people are working Americans who would lose Medicaid because of the onerous paperwork involved with the proposed work requirements. They wouldn't be able to get coverage in the Affordable Care Act Marketplaces after losing Medicaid. Premiums and out-of-pocket costs are likely to be too high for those making less than 100% to 138% of the federal poverty level who do not qualify for health insurance marketplace subsidies. Funding for this program is also under threat. And despite being employed, they also wouldn't be able to get health insurance through their employers because it is either too expensive or not offered to them. Researchers estimate that coverage losses would lead to thousands of medically preventable deaths across the country because people would be unable to access health care without insurance. I am a physician, health economist and policy researcher who has cared for patients on Medicaid and written about health care in the United States for more than eight years. I think it's important to understand the role of Medicaid within the broader insurance landscape. Medicaid has become a crucial source of health coverage for low-wage workers. Michigan removed work requirements from Medicaid A few years ago, Michigan was slated to institute Medicaid work requirements, but the courts blocked the implementation of that policy in 2020. It would have cost upward of $70 million due to software upgrades, staff training, and outreach to Michigan residents enrolled in the Medicaid program, according to the Michigan Department of Health and Human Services. Had it gone into effect, 100,000 state residents were expected to lose coverage within the first year. The state took the formal step of eliminating work requirements from its statutes earlier this year in recognition of implementation costs being too high and mounting evidence against the policy's effectiveness. When Arkansas instituted Medicaid work requirements in 2018, there was no increase in employment, but within months, thousands of people enrolled in the program lost their coverage. The reason? Many people were subjected to paperwork and red tape, but there weren't actually that many people who would fail to meet the criteria of the work requirements. It is a recipe for widespread coverage losses without meeting any of the policy's purported goals. Work requirements, far from incentivizing work, paradoxically remove working people from Medicaid with nowhere else to go for insurance. Shortcomings of employer-sponsored insurance Nearly half of Americans get their health insurance through their employers. In contrast to a universal system that covers everyone from cradle to grave, an employer-first system leaves huge swaths of the population uninsured. This includes tens of millions of working Americans who are unable to get health insurance through their employers, especially low-income workers who are less likely to even get the choice of coverage from their employers. More than 80% of managers and professionals have employer-sponsored health coverage, but only 50% to 70% of blue-collar workers in service jobs, farming, construction, manufacturing and transportation can say the same. There are some legal requirements mandating employers to provide health insurance to their employees, but the reality of low-wage work means many do not fall under these legal protections. For example, employers are allowed to incorporate a waiting period of up to 90 days before health coverage begins. The legal requirement also applies only to full-time workers. Health coverage can thus remain out of reach for seasonal and temporary workers, part-time employees and gig workers. Even if an employer offers health insurance to their low-wage employees, those workers may forego it because the premiums and deductibles are too high to make it worth earning less take-home pay. To make matters worse, layoffs are more common for low-wage workers, leaving them with limited options for health insurance during job transitions. And many employers have increasingly shed low-wage staff, such as drivers and cleaning staff, from their employment rolls and contracted that work out. Known as the fissuring of the workplace, it allows employers of predominately high-income employees to continue offering generous benefits while leaving no such commitment to low-wage workers employed as contractors. Medicaid fills in gaps Low-income workers without access to employer-sponsored insurance had virtually no options for health insurance in the years before key parts of the Affordable Care Act went into effect in 2014. Research my co-authors and I conducted showed that blue-collar workers have since gained health insurance coverage, cutting the uninsured rate by a third thanks to the expansion of Medicaid eligibility and subsidies in the health insurance marketplaces. This means low-income workers can more consistently see doctors, get preventive care and fill prescriptions. Further evidence from Michigan's experience has shown that Medicaid can help the people it covers do a better job at work by addressing health impairments. It can also improve their financial well-being, including fewer problems with debt, fewer bankruptcies, higher credit scores and fewer evictions. Premiums and cost sharing in Medicaid are minimal compared with employer-sponsored insurance, making it a more realistic and accessible option for low-income workers. And because Medicaid is not tied directly to employment, it can promote job mobility, allowing workers to maintain coverage within or between jobs without having to go through the bureaucratic complexity of certifying work. Of course, Medicaid has its own shortcomings. Payment rates to providers are low relative to other insurers, access to doctors can be limited, and the program varies significantly by state. But these weaknesses stem largely from underfunding and political hostility - not from any intrinsic flaw in the model. If anything, Medicaid's success in covering low-income workers and containing per-enrollee costs points to its potential as a broader foundation for health coverage. The current employer-based system, which is propped up by an enormous and regressive tax break for employer-sponsored insurance premiums, favors high-income earners and contributes to wage stagnation. In my view, which is shared by other health economists, a more public, universal model could better cover Americans regardless of how someone earns a living. Over the past six decades, Medicaid has quietly stepped into the breach left by employer-sponsored insurance. Medicaid started as a welfare program for the needy in the 1960s, but it has evolved and adapted to fill the needs of a country whose health care system leaves far too many uninsured. Sumit Agarwal is an assistant professor of internal medicine at the University of Michigan. This article is republished from The Conversation under a Creative Commons license. Read the original article. The views and opinions in this commentary are solely the views of the author.
Yahoo
03-07-2025
- Health
- Yahoo
Employers are failing to insure the working class – Medicaid cuts would leave them even more vulnerable
The Congressional Budget Office estimates that 7.8 million Americans across the U.S. would lose their coverage through Medicaid – the public program that provides health insurance to low-income families and individuals – under the One Big Beautiful Bill Act making its way through Congress. That includes 248,000 to 414,000 of my fellow residents of Michigan based on the House Reconciliation Bill in early June 2025. There are similarly deep projected cuts within the Senate version of the legislation. Many of these people are working Americans who would lose Medicaid because of the onerous paperwork involved with the proposed work requirements. They wouldn't be able to get coverage in the Affordable Care Act Marketplaces after losing Medicaid. Premiums and out-of-pocket costs are likely to be too high for those making less than 100% to 138% of the federal poverty level who do not qualify for health insurance marketplace subsidies. Funding for this program is also under threat. And despite being employed, they also wouldn't be able to get health insurance through their employers because it is either too expensive or not offered to them. Researchers estimate that coverage losses would lead to thousands of medically preventable deaths across the country because people would be unable to access health care without insurance. I am a physician, health economist and policy researcher who has cared for patients on Medicaid and written about health care in the U.S. for over eight years. I think it's important to understand the role of Medicaid within the broader insurance landscape. Medicaid has become a crucial source of health coverage for low-wage workers. A few years ago, Michigan was slated to institute Medicaid work requirements, but the courts blocked the implementation of that policy in 2020. It would have cost upward of US$70 million due to software upgrades, staff training, and outreach to Michigan residents enrolled in the Medicaid program, according to the Michigan Department of Health and Human Services. Had it gone into effect, 100,000 state residents were expected to lose coverage within the first year. The state took the formal step of eliminating work requirements from its statutes earlier this year in recognition of implementation costs being too high and mounting evidence against the policy's effectiveness. When Arkansas instituted Medicaid work requirements in 2018, there was no increase in employment, but within months, thousands of people enrolled in the program lost their coverage. The reason? Many people were subjected to paperwork and red tape, but there weren't actually that many people who would fail to meet the criteria of the work requirements. It is a recipe for widespread coverage losses without meeting any of the policy's purported goals. Work requirements, far from incentivizing work, paradoxically remove working people from Medicaid with nowhere else to go for insurance. Nearly half of Americans get their health insurance through their employers. In contrast to a universal system that covers everyone from cradle to grave, an employer-first system leaves huge swaths of the population uninsured. This includes tens of millions of working Americans who are unable to get health insurance through their employers, especially low-income workers who are less likely to even get the choice of coverage from their employers. Over 80% of managers and professionals have employer-sponsored health coverage, but only 50% to 70% of blue-collar workers in service jobs, farming, construction, manufacturing and transportation can say the same. There are some legal requirements mandating employers to provide health insurance to their employees, but the reality of low-wage work means many do not fall under these legal protections. For example, employers are allowed to incorporate a waiting period of up to 90 days before health coverage begins. The legal requirement also applies only to full-time workers. Health coverage can thus remain out of reach for seasonal and temporary workers, part-time employees and gig workers. Even if an employer offers health insurance to their low-wage employees, those workers may forego it because the premiums and deductibles are too high to make it worth earning less take-home pay. To make matters worse, layoffs are more common for low-wage workers, leaving them with limited options for health insurance during job transitions. And many employers have increasingly shed low-wage staff, such as drivers and cleaning staff, from their employment rolls and contracted that work out. Known as the fissuring of the workplace, it allows employers of predominately high-income employees to continue offering generous benefits while leaving no such commitment to low-wage workers employed as contractors. Low-income workers without access to employer-sponsored insurance had virtually no options for health insurance in the years before key parts of the Affordable Care Act went into effect in 2014. Research my co-authors and I conducted showed that blue-collar workers have since gained health insurance coverage, cutting the uninsured rate by a third thanks to the expansion of Medicaid eligibility and subsidies in the health insurance marketplaces. This means low-income workers can more consistently see doctors, get preventive care and fill prescriptions. Further evidence from Michigan's experience has shown that Medicaid can help the people it covers do a better job at work by addressing health impairments. It can also improve their financial well-being, including fewer problems with debt, fewer bankruptcies, higher credit scores and fewer evictions. Premiums and cost sharing in Medicaid are minimal compared with employer-sponsored insurance, making it a more realistic and accessible option for low-income workers. And because Medicaid is not tied directly to employment, it can promote job mobility, allowing workers to maintain coverage within or between jobs without having to go through the bureaucratic complexity of certifying work. Of course, Medicaid has its own shortcomings. Payment rates to providers are low relative to other insurers, access to doctors can be limited, and the program varies significantly by state. But these weaknesses stem largely from underfunding and political hostility – not from any intrinsic flaw in the model. If anything, Medicaid's success in covering low-income workers and containing per-enrollee costs points to its potential as a broader foundation for health coverage. The current employer-based system, which is propped up by an enormous and regressive tax break for employer-sponsored insurance premiums, favors high-income earners and contributes to wage stagnation. In my view, which is shared by other health economists, a more public, universal model could better cover Americans regardless of how someone earns a living. Over the past six decades, Medicaid has quietly stepped into the breach left by employer-sponsored insurance. Medicaid started as a welfare program for the needy in the 1960s, but it has evolved and adapted to fill the needs of a country whose health care system leaves far too many uninsured. This article is republished from The Conversation, a nonprofit, independent news organization bringing you facts and trustworthy analysis to help you make sense of our complex world. It was written by: Sumit Agarwal, University of Michigan Read more: When you lose your health insurance, you may also lose your primary doctor – and that hurts your health House tax-and-spending bill and other Trump administration changes could make millions of people lose their health insurance coverage Why do cuts to Medicaid matter for Americans over 65? 2 experts on aging explain why lives are at stake Sumit Agarwal does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
Yahoo
23-05-2025
- Business
- Yahoo
Analysis: Upwards of 80K Utahns could lose health insurance under ‘big, beautiful' bill'
A supporter wears an "I love Medicaid" button during a news conference held at Pioneer Park in Salt Lake City on May 6, 2025. (Katie McKellar/Utah News Dispatch) Though the full ramifications of the 'big, beautiful' tax and spending bill that narrowly passed the U.S. House this week are still murky — especially since the bill is likely to change as it makes its way through the Senate — the bill as currently written could jeopardize health insurance for tens of thousands of Utahns. Plus, states including Utah would need to grapple with an estimated $625 billion in cumulative Medicaid cuts over 10 years from work requirements, stricter eligibility rules and a pause on provider taxes — changes that would likely lead millions of Americans losing Medicaid coverage. On Friday, officials from the Utah Department of Health and Human Services told Utah News Dispatch they did not have state-specific estimates available detailing the potential impacts of the still-evolving federal budget reconciliation package on Utah's Medicaid program because it's still a 'moving target.' U.S. House Republicans push through massive tax and spending bill slashing Medicaid However, according to the health policy outlet KFF, the bill could result in an estimated $381 million loss in federal Medicaid dollars for Utah. The outlet used Congressional Budget Office (CBO) estimates to unpack the potential state-by-state impacts of a $625 billion federal cut to Medicaid in an analysis posted last week. 'Cuts of $625 billion will force states to make tough choices: maintain current spending on Medicaid by raising taxes or reducing spending on other programs; or cut Medicaid spending by covering fewer people, offering fewer benefits, or paying providers less,' KFF reported. The vast majority of the cut would come from three sources: work requirements mandating that adults who are eligible for Medicaid expansion must meet work and reporting requirements (estimated to save $300.8 billion as people become ineligible), repealing the Biden administration's rule simplifying eligibility and renewal process (estimated to save $162.7 billion) and setting a moratorium on new or increased provider taxes (estimated to save $86.8 billion), accordion to KFF. It depends on what states decide to do to respond to the cuts, but in another analysis posted Tuesday based on CBO estimates, KFF estimated the changes to Medicaid and the Affordable Care Act Marketplaces could increase the number of people without health insurance across the nation by 8.6 million. Additionally, when combined with the effect of the expected expiration of the Affordable Care Act's enhanced premium tax credits, the CBO expects 13.7 million more people will be uninsured in 2034, according to KFF. 'Anticipating how states will respond to changes in Medicaid policy is a major source of uncertainty in CBO's cost estimates. Instead of making state-by-state predictions about policy responses, CBO estimates the percentage of the affected population that lives in states with different types of policy responses,' KFF noted, adding that states may choose to implement work requirements that are easier or harder to comply with, which would impact enrollment. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX So KFF's analysis included a range of enrollment impacts varying by plus or minus 25% from a midpoint estimate. Based on the budget reconciliation bill's changes to Medicaid, Utah is projected to see its uninsured population increase by a mid-range estimate of roughly 65,000 — somewhere between 49,000 on the low end and up to 81,000 on the high end, according to the analysis. When combined with the expected expiration of the Affordable Care Act's enhanced premium tax credits, KFF estimated that Utah's uninsured population could increase by even more — roughly 150,000, or a 4% increase. That estimate could vary between 110,000 on the low end or up to 190,000 on the high end, according to KFF. Other states would see bigger impacts than Utah, where about 350,000 total Utahns enroll in Medicaid. About half of the 13.7 million more people who would be uninsured under both policy changes live in Florida (1.8 million), Texas, (1.6 million), California (1.5 million), New York (800,000), and Georgia (610,000). Utah health advocates who have been watching the budget reconciliation bill's progress expressed deep disappointment in its passage out of the House. 'I've yet to meet any Utahn who said that when they voted in November, they were looking for which candidate was most focused on kicking as many people off Medicaid,' said Stephanie Burdick, an advocate with the newly-formed Protect Medicaid Utah Coalition. 'Yet here we are,' Burdick said. 'The U.S. House of Representatives passed a bill that could force almost 80,000 Utahns off their health insurance.' The proposed federal cuts also come as Utah state officials — anticipating the Republican-controlled White House and Congress' appetite to implement work requirements on Medicaid — are considering a waiver to impose work requirements on Utah's adult Medicaid adult expansion population. About 75,000 Utahns have enrolled in Utah's Medicaid expansion program, an estimated 7,500 (10%), would not qualify for an exemption and be subject to the work requirements. That means that if they don't start working or submit documents showing they're applying for at least 48 jobs during a three-month period, they could lose their medical coverage. Between Utah's proposed work requirements and the proposed federal Medicaid cuts, Burdick said state officials and federal politicians in D.C. are 'both deadset on one thing: increasing the number of uninsured Utahns and squeezing more time and more money out of working families.' 'How is this aligned with Utah values?' Burdick said, urging Congress to 'go back to the drawing board and find ways to increase access and affordability to health care for all Americans and this is the opposite.' Advocates sound alarm as Utah looks to impose work requirements on Medicaid expansion Nate Crippes with the Disability Law Center, also a member of the Protect Medicaid Utah Coalition, issued a statement saying health advocates 'remain concerned about the devastating impact of the billions of dollars in Medicaid cuts on Utahns with disabilities.' 'Numerous provisions in this bill would be harmful to the disability community, including a work requirement that penalizes Medicaid beneficiaries for losing a job, and will strip health coverage from millions nation-wide, including many Utahns,' Crippes said. He added that given the focus on people enrolled in Medicaid expansion, 'we are particularly concerned with the impact on those with mental illness and substance use disorder, who make up nearly 60% of the expansion population.' 'We see no beauty in a bill that denies healthcare to millions, shifts costs to the states and the middle class, and weakens our entire healthcare system,' he said. 'So we urge our senators to support the disability community, protect Medicaid, and stop this bill from passing.' President Donald Trump and Republicans in Congress have lauded the bill as needed to curb government spending, cut taxes and provide resources to execute Trump's agenda around immigration, energy production and increased military investment. Democrats criticized the bill as a tax cut that would largely benefit the billionaire class and lead the U.S. to raise its debt limit by $4 trillion. Utah's Medicaid Director Jennifer Strohecker briefed Utah lawmakers this week on the status of Utah's Medicaid program, proposed changes including the state's version of work requirements, and possible impacts from the budget reconciliation bill if it receives final passage. 'Utah has the lowest Medicaid enrollment of every state, but for the 350,000 Utahns that do receive their health benefits through this program, it is a lifeline for preventive care, institutional care when it's needed, physical health, behavioral health,' she told the state Health and Human Services Interim Committee on Wednesday. An estimated 1 in 10 Utahns are enrolled in Medicaid, she said. One in 6 babies are born with Medicaid as their health coverage. In total, Utah's Medicaid program costs about $5.3 billion per year. More than 64% of it is funded with federal dollars, equaling $3.4 billion. About $1.7 in state dollars pay for the rest. 'Counterproductive and cruel': Advocates form coalition to protect Medicaid from federal cuts Lawmakers including Rep. Tyler Clancy, R-Provo, and Rep. Ray Ward, R-Bountiful, asked Strohecker about Utah's proposed work requirement waiver and questioned whether it will lead to Utahns losing coverage due to administrative burdens. 'This was not meant to be an administrative hurdle or a barrier. This was not meant to take people off of the Medicaid program,' she said of Utah's proposal. While Strohecker noted the federal proposal has a 'pretty big dollar figure tied to work requirements as it's proposed, Utah's design did not have that intent.' 'So it is our commitment to look at what are those administrative hurdles, what are those barriers, as it's designed today, and thoughtfully work through those with you all and with our partners at DWS,' she said, noting that Utah's proposal is still being drafted using feedback from public comment. Though the original public comment period for Utah's proposed work requirements waiver was initially scheduled to end Thursday, state officials told Utah News Dispatch they decided to extend it through June 2, with one more public hearing scheduled for Tuesday. 'We have received a lot of helpful feedback and will consider those recommendations before submitting the request to (the federal government) within a month or two of closing the public comment period,' a Utah Department of Health and Human Services spokesperson said in an email. However, Strohecker noted that Utah's waiver and the federal mandates included in the budget reconciliation package are two different proposals. The proposed federal mandated work requirements would require Americans to 'complete work requirements before you ever get Medicaid.' The federal proposal has the potential to risk loss of health coverage for tens of thousands more Utahns than the state's work requirement waiver, as currently drafted. Additionally, if Congress approves the bill as currently drafted, it included a provision that would penalize states that expanded coverage for immigrants by reducing the federal Medicaid matching rate for the Medicaid expansion program from 90% to 80% for states that either provide health coverage or financial assistance to purchase health coverage to certain groups of immigrants. 'I have a hard enough time': Utahns urge state not to impose work requirements on Medicaid Last year, Utah started offering health insurance to noncitizen children through its State Children's Health Insurance Program, or CHIP. As of last week, 1,317 children were enrolled in that program, which has the capacity to cover up to 2,000 kids, according to the state's website. Strohecker said that if the federal government penalizes Utah for its CHIP program and reduces its state match from 90% to 80%, that would trigger a law to 'terminate' Utah's adult Medicaid expansion program. She said lawmakers may need to consider what to do about that. That may include repealing the state's CHIP program for 2,000 kids in order to save Utah's Medicaid expansion program, which covers 75,000 adults. Rep. Steve Eliason, R-Sandy, acknowledged the federal bill is 'constantly evolving,' so state leaders will need to watch what happens, but he said 'assuming this bill passes, if this provision is left in there,' lawmakers may need to repeal CHIP. 'I think it's a really simple policy call, myself, that we need to sunset the (CHIP) program that would trigger the 10% penalty as well as our trigger law, because that would be a domino effect,' Eliason said. 'This is not making a policy comment on the underlying legislation, it's just that our hands would be tied, and it would be, I think, the greatest good for the greatest number.' Senate Minority Leader Luz Escamilla, D-Salt Lake City, also acknowledged that the federal budget package is a 'moving target, so who knows what it's going to look like in the next week.' But she asked whether the Utah Legislature would need to convene in a special session to deal with fallout if the bill receives final passage before lawmakers' next general session in January. Strohecker said that's a possibility. 'We've been keeping a very close eye on this legislation,' she said. SUPPORT: YOU MAKE OUR WORK POSSIBLE
